The time for tobacco industry sponsored PREP evaluation has arrived.
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Financing, Organized↗
Biomedical subjects
T Eissenberg
Publications and source records attributed to T Eissenberg.
The tobacco epidemic in Syria.
BACKGROUND: The Syrian Center for Tobacco Studies (SCTS) was established in response to the smoking epidemic in Syria and lack of local knowledge and expertise to confront it. OBJECTIVES: To (1) study tobacco use and local smoking practices using both qualitative and quantitative research methods; (2) develop and test an effective smoking cessation intervention for the Syrian environment; and (3) train Syrian researchers. METHODS AND RESULTS: The Aleppo Household Survey involved a representative sample of adults in Aleppo (2038 subjects, 45.2% men, mean age 35.3 years, response rate 86%). The prevalence of cigarette smoking was 56.9% among men and 17.0% among women, while the prevalence of waterpipe smoking was 20.2% among men and 4.8% among women. Daily use predominated for cigarettes (29.0%), while the opposite was seen in waterpipe use with 10.6% smoking occasionally. Interest in quitting was greater for cigarette than waterpipe smokers (74.0% v 48.6%), while quit rates were higher for waterpipe compared to cigarettes (28.2% v 16.5%). In-depth ethnographic interviews with smokers show that smoking waterpipe is often viewed as an aesthetic enjoyable experience, while smoking cigarettes is viewed as a mundane anxiety-relieving addiction. Clinical laboratory studies reveal that both waterpipe and cigarette smokers in Syria are exposed to smoke toxicants and exhibit dependence symptoms. CONCLUSIONS: All these data have been used iteratively to adapt smoking cessation interventions from developed countries to suit the local Syrian environment. Research conducted in the SCTS to date has provided a fertile training ground for Syrian researchers, as well as for the building of regional collaborations.
Adult↗
Standardizing questionnaire items for the assessment of waterpipe tobacco use in epidemiological studies.
Lessons from surveillance of the smoking epidemic show that the lack of adequate attention to standardizing measures and instruments for epidemiological studies has negatively influenced our ability to assess spatial and secular trends in smoking worldwide. Waterpipe smoking, another hazardous form of tobacco use, is gaining popularity worldwide, with societies in the Eastern Mediterranean region (EMR) being most affected. Several research groups are currently investigating the epidemiology of waterpipe smoking among various populations in the EMR. Initial evidence shows that in contrast to usage patterns observed in adult cigarette smoking, waterpipe smoking is characterized mainly by intermittent and social use. As such, many measures that have been traditionally used for the study of usage patterns and dependence among adult cigarette smokers are uninformative for waterpipe smoking. Thus, the need to develop standardized measures and terminology for assessment of the epidemiology of waterpipe smoking in different populations is of paramount importance. As the monitoring of waterpipe smoking is in its infancy, the development of consensus measures should facilitate the initiation of effective surveillance that can guide public health response to this emerging epidemic.
Adult↗
Patterns of waterpipe use and dependence: implications for intervention development.
Despite the dramatic increase of tobacco smoking via waterpipe in Arab societies, and the apparent potential of waterpipe use to produce tobacco-related disease, little is known about the pharmacological effects of this method of tobacco smoking, particularly its ability to support dependence. This review focuses on recent waterpipe research and current theories of dependence in an attempt to identify patterns of waterpipe use and features likely to reveal dependence. Recent work indicates that, relative to cigarette smoking, this form of tobacco use is characterized by more intermittent use, later age of onset, greater spread among women and lower interest in quitting or appreciation of addictive properties. Waterpipe use is associated with classic features of tobacco/nicotine dependence, as well as features unique to this tobacco use method. However, even shared features of dependence, such as craving and addiction-induced socio-cognitive behavioral changes, can be displayed differently in waterpipe users, indicating the need for waterpipe-specific research approaches. Preliminary evidence suggests that an important step toward dependence involves a transition from social to individual patterns of waterpipe use. Surveillance and research into factors affecting use and cessation of this tobacco use method should pave the way for the development of effective prevention and intervention strategies to curb the burgeoning waterpipe use epidemic.
Confidence Intervals↗
Factors related to frequency of narghile (waterpipe) use: the first insights on tobacco dependence in narghile users.
AIMS: To evaluate factors related to level of narghile (waterpipe) use as a first step towards modeling tobacco dependence among narghile users. DESIGN: Cross sectional survey done in 2003 using interviewer-administered anonymous questionnaires. SETTING: Cafes/restaurants serving narghiles in Aleppo, Syria. PARTICIPANTS: Narghile smokers (161 men and 107 women; mean age, 30.1 +/- 10.2, 161; age range, 18-68 years; response rate, 95.3%) randomly selected from the 17 cafes/restaurants sampled. MEASUREMENTS: Frequency of narghile use (daily, weekly, monthly) was assessed as a function of several factors potentially indicative of dependence, including situational characteristics (where, when, and with whom smoking occurs; seasonality of use, and sharing of narghile), attitudes, and experience with quitting narghile use, escalation of use over time, future intentions regarding use, perception of being "hooked" on narghile, and cognitions/behaviors engaged in to support use (carrying one's own narghile; think of narghile when it is not available; considering narghile for selection of cafes/restaurants). FINDINGS: Frequency of narghile use was strongly correlated with participant's subjective judgment of how hooked they are on narghile (coefficient, 0.5). Predictors of narghile use frequency according to multinomial logistic regression were: male gender, smoking mainly alone versus with others; smoking mainly at home versus outside; smoking more frequently since initiation, being hooked on narghile, carrying narghile, and considering it for cafe/restaurant choice. CONCLUSIONS: Our data reveal two main domains of a tobacco dependence syndrome likely to be relevant to narghile; the first reflects the effects of nicotine contained in narghile tobacco, and is not very different from what is seen with other tobacco products, and the second is unique to narghile and is related mainly to its social dimension, with more intensive smokers showing an increasingly individual pattern of narghile smoking.
Adolescent↗
Gender and smoking status-based analysis of views regarding waterpipe and cigarette smoking in Aleppo, Syria.
BACKGROUND: Narghile (waterpipe) smoking is increasing across the Eastern Mediterranean region (EMR), though little is known about the social attitudes and perceptions related to this method of tobacco use, and how those attitudes and perceptions are influenced by gender. METHODS: Data from two cross-sectional surveys conducted in 2003 in Aleppo, Syria, were used to examine these issues. Overall, 855 participants were included (439 men, 416 women; mean age, 24.4+/-7.1 years; response rate, 97%). The current analysis focuses on responses to four similar nine-item questions tapping perceptions related to narghile smoking by women or men, and cigarette smoking by women or men. Scores on the nine items were summed to yield a total score to gauge participants' perceptions about narghile and cigarette. RESULTS: Generally, participants were less positive about women smoking relative to men smoking, and cigarette smoking relative to narghile smoking. Cigarette smoking by women was the behavior least associated with positive perceptions. Individuals who resided in the city, were economically better-off, and were Christian, had higher perception scores (i.e., more positive attitudes) toward all forms of smoking, whereas older and married participants had higher perception scores for narghile only. Smoking status of participants, especially narghile smoking, was also associated with more positive perceptions toward smoking in general. CONCLUSIONS: We conclude that preliminary analysis shows that views on different forms of smoking in Syria differ by gender and smoking status.
Adolescent↗
Characteristics of cigarette smoking and quitting among university students in Syria.
BACKGROUND: No study to date in Syria has documented the smoking and quitting characteristics in a representative sample of university students, and this study aims to fill this void. DESIGN: In 2003, a cross-sectional survey was carried out among students at Aleppo University using an interviewer-administered questionnaire. Overall, 587 students participated in the study (278 males, 309 females; mean age, 21.8 +/- 2.1 years; response rate, 98.8%). Experiences and attitudes related to smoking and quitting were assessed for two popular forms of tobacco use in Syria-cigarettes and narghile (waterpipe). RESULTS: Current cigarette smoking was reported by 30.9% of male and 7.4% of female students and daily smoking by 24.8% of male and 5.2% of female students. Narghile smoking was seen among 25.5% of men and 4.9% of women, mostly on an occasional basis. More than half of current smokers (56%) believed they could quit cigarettes, 75.2% were interested in quitting, and 78% of those had made a quit attempt in the past year. Important correlates of cigarette smoking among students were being older, male, and smoking narghile, while being older and from a poorer family were associated with increased interest in quitting. Interestingly, peers' smoking was associated with current smoking among students, but inversely with their willingness to quit. CONCLUSIONS: Cigarette smoking is mainly a problem of male students, whose narghile smoking is likely to be dramatically increasing as well, sometimes practiced as a substitute for cigarettes. The findings that most smokers in this sample are interested in quitting smoking and have tried unsuccessfully to do so indicate that cessation support for youths in this country is urgently needed.
Adult↗
Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic.
CONTEXT: The global tobacco epidemic may kill 10 million people annually in the next 20-30 years, with 70% of these deaths occurring in developing countries. Current research, treatment, and policy efforts focus on cigarettes, while many people in developing regions (Asia, Indian subcontinent, Eastern Mediterranean) smoke tobacco using waterpipes. Waterpipes are increasing in popularity, and more must be learned about them so that we can understand their effects on public health, curtail their spread, and help their users quit. OBJECTIVE: To conduct a comprehensive review regarding global waterpipe use, in order to identify current knowledge, guide scientific research, and promote public policy. DATA SOURCES: A Medline search using as keywords "waterpipe", "narghile", "arghile", "shisha", "hookah", "goza", "hubble bubble" and variant spellings (for example, "hooka"; "hukka") was conducted. Resources compiled recently by members of GLOBALink were used. STUDY SELECTION: Every identified published study related to waterpipe use was included. DATA SYNTHESIS: Research regarding waterpipe epidemiology and health effects is limited; no published studies address treatment efforts. Waterpipe use is increasing globally, particularly in the Eastern Mediterranean Region, where perceptions regarding health effects and traditional values may facilitate use among women and children. Waterpipe smoke contains harmful constituents and there is preliminary evidence linking waterpipe smoking to a variety of life threatening conditions, including pulmonary disease, coronary heart disease, and pregnancy related complications. CONCLUSIONS: More scientific documentation and careful analysis is required before the spread of waterpipe use and its health effects can be understood, and empirically guided treatment and public policy strategies can be implemented.
Carbon Monoxide↗
Adapting smoking cessation interventions for developing countries: a model for the Middle East.
OBJECTIVE: To describe the rationale and methods for the development of culturally-sensitive smoking cessation interventions for primary care settings in developing countries. RATIONALE: Smokers in the Middle East have great difficulty quitting. Effective smoking cessation programs are currently lacking in the Middle East, and the development of culturally sensitive programs is hindered by the dearth of standardized information regarding tobacco use and dependence in this region. METHODS: Epidemiological and clinical laboratory methods are needed to determine the prevalence and patterns of tobacco use and nicotine dependence. One strategy is to adapt smoking cessation methods widely used in industrialized countries to the Syrian and Middle Eastern environment. In a recently initiated project, the Syrian Center for Tobacco Studies has been established to address these issues. Initial work is focusing on collecting formative data including key informant interviews, focus groups, and epidemiological surveys to assess smokers' use patterns, needs, and resources. Clinical laboratory techniques are also being applied to assess the physiological, behavioral, and subjective effects of local tobacco use methods, such as narghile (water pipe) smoking. These data will be used to help adapt existing smoking cessation interventions from industrialized countries to be evaluated in a randomized controlled trial. CONCLUSION: There is a great need to develop and disseminate effective cessation interventions in low-income countries. Successful interventions will contribute to a culturally sensitive and sustainable regional tobacco control infrastructure. This paper describes one approach to the development of such an infrastructure that is currently underway in the Middle East.
Developing Countries↗
Prevalence and characteristics of narghile smoking among university students in Syria.
SETTING: Narghile (waterpipe) smoking is increasing in all Arab societies, but little is known about its pattern of use. METHODS: In 2003, a cross-sectional survey was conducted among students at Aleppo University using an interviewer-administered questionnaire. A representative sample of 587 students participated (278 males, 309 females; mean age 21.8 +/- 2.1 years; response rate 98.8%). RESULTS: Ever narghile smoking was seen among 62.6% of men and 29.8% of women, while current smoking was seen among 25.5% of men and 4.9% of women. Only 7.0% of the men used narghile daily. Age of initiation was 19.2 +/- 2.2 and 21.7 +/- 3.2 years for men and women, respectively (P < 0.001). The salient feature of narghile smoking was its social pattern, where most users initiated and currently smoked narghile with friends. Narghile and cigarette smoking were related among students, with narghile smoking most prevalent among daily cigarette smokers. Multivariate correlates of narghile smoking were being older, male, originating from the city, smoking cigarettes, having friends who smoke narghile, and coming from a household where a greater number of narghiles were smoked daily. CONCLUSIONS: Narghile smoking is prevalent among university students in Syria, where it is mainly practiced by men, intermittently, and in the context of social activities with friends.
Adult↗
Tobacco specific nitrosamines and potential reduced exposure products for smokers: a preliminary evaluation of Advance.
OBJECTIVE: To develop a method for evaluating the carcinogen delivery of potential reduced exposure products (PREPs) like Advance, a PREP marketed to reduce smokers' exposure to one tobacco specific nitrosamine (TSN), NNK, a potent lung carcinogen. DESIGN, SETTING, AND PARTICIPANTS: Latin square ordered, three condition, outpatient, crossover design with 12 smokers of light or ultra-light cigarettes (15 or more cigarettes/day). In each five day condition, participants either smoked own brand, Advance, or no cigarettes. Also, on the first and last day of each condition, participants smoked one cigarette in the laboratory. MAIN OUTCOME MEASURES: Subject rated measures of tobacco/nicotine withdrawal, expired air carbon monoxide, urine concentrations of cotinine and NNAL (one TSN biomarker), puff volume, duration, number, and interpuff interval. RESULTS: Relative to own brand, Advance produced similar withdrawal suppression, slightly lower carbon monoxide, equivalent cotinine, and 51% lower NNAL concentrations. The lowest cotinine and NNAL concentrations were observed in the no cigarette condition. Participants took fewer puffs when smoking Advance. CONCLUSIONS: Past experience with PREPs that failed to reduce smoking's harm demonstrates the need for clinical methods in PREP evaluation. This study shows how assessing PREP induced changes in withdrawal and exposure to carbon monoxide, nicotine, and carcinogens may help predict PREP harm reduction potential. Adequate withdrawal suppression, slightly lower concentrations of carbon monoxide, and reduction of one TSN biomarker were observed for Advance. In the future, clinical methods like those described here may be valuable for evaluating PREPs before they are marketed publicly.
Adolescent↗
Acute effects of Advance: a potential reduced exposure product for smokers.
OBJECTIVE: To examine the acute effects of Advance, a potential reduced exposure product (PREP) for smokers marketed as a means to reduce exposure to toxic gases and tobacco specific nitrosamines. DESIGN, SETTING, PARTICIPANTS: Latin square ordered, three condition, laboratory based, crossover design with 20 smokers of light or ultra-light cigarettes (15 or more cigarettes/day). In each 2.5 hour condition, participants completed an 8-puff smoking bout from their own brand, Advance, or an unlit cigarette (that is, sham smoking) every 30 minutes for a total of four bouts. MAIN OUTCOME MEASURES: Subject rated measures of tobacco/nicotine withdrawal; carbon monoxide (CO), and heart rate; plasma nicotine concentrations. RESULTS: Relative to own brand, Advance produced similar withdrawal suppression and heart rate increase, lower CO boost, and higher plasma nicotine concentrations. CONCLUSIONS: PREPs for smokers need to be evaluated using a comprehensive strategy that includes empirical examination of acute and long term effects. Adequate withdrawal suppression and potentially lower concentrations of CO associated with Advance use are positive factors, although higher nicotine concentrations do not constitute "reduced exposure". Overall, longer exposure periods are necessary to determine carcinogen delivery. PREP evaluation is complex and should be completed objectively.
Adolescent↗
Effects of abstinence and smoking on information processing in adolescent smokers.
RATIONALE: Although adolescent smokers appear to display some of the hallmark features of dependence, the biological and behavioral effects of smoking in this population are poorly understood. OBJECTIVES: This study aimed to define empirically the effects of abstinence and smoking in adolescent smokers, using indices validated in adult smokers. METHODS: Subjects were 16 young novice smokers (five male, 11 female), ages 14-18 years. A modified Stroop task measured the ability to inhibit attention to smoking-related cues; the classic Stroop task measured the ability to inhibit a pre-potent response (i.e. reading a word); a rapid information processing (RIP) task measured vigilance. RESULTS: Abstinence increased and smoking decreased the intrusiveness of smoking cues. Parallel effects were seen in commission errors on the RIP task. These effects were restricted to heavier smokers (>11 cigarettes/day). Subjective withdrawal effects predicted the intrusiveness of smoking words during abstinence. The number of cigarettes smoked per day predicted the beneficial effect of smoking on the classic as well as modified Stroop tasks. The physiological effects of abstinence and smoking predicted RIP performance. CONCLUSIONS: Abstinence impairs and smoking improves inhibitory information processing in young novice smokers in a manner similar to adult smokers. Daily frequency of smoking is a critical moderator of these effects.
Adolescent↗
Acute subjective and physiological responses to smoking in adolescents.
AIMS: To determine the topography of cigarette smoking and the subjective and physiological effects of abstinence and nicotine in adolescents who smoke on a daily versus a non-daily basis. DESIGN: Repeated measures experiment, non-blinded, involving a single test session. SETTING: Human psychopharmacology laboratory. PARTICIPANTS: Twenty-one daily and 21 non-daily adolescent cigarette smokers (21 females; 21 males; age 13-18 years) with life-time use greater than 10 cigarettes, responding to radio and print advertisements. INTERVENTION: Overnight abstinence from cigarettes followed by smoking of a single cigarette furnished by the participant at test. MEASUREMENTS: The Fagerstrom Test for Nicotine Dependence, saliva nicotine and cotinine, expired air carbon monoxide (CO), heart rate (HR), self-report scales and smoking topography. Most measurements were performed before and after smoking. FINDINGS: Saliva nicotine, CO and HR increased, and self-reported intention and desire to smoke decreased, after smoking (p < 0.001). Fagerstrom scores indicated greater dependence and desire to smoke in daily than in non-daily smokers. HR increased substantially over pre-smoking levels in both groups. Puff topography did not differ between the groups, although collectively these participants appeared to take smaller and more puffs than adult smokers tested under similar conditions. CONCLUSION: This study provides initial evidence that adolescent cigarette smokers self-administer physiologically active doses of nicotine very early in their smoking careers. Nicotine dependence in adolescents appears to be a function of the current frequency of cigarette use, and subjective-behavioral consequences of abstinence and smoking are evident even in non-daily smokers.
Adolescent↗
Withdrawal-suppressing effects of a novel smoking system: comparison with own brand, not own brand, and de-nicotinized cigarettes.
Tobacco smoking is associated with many health risks, all of which are decreased by smoking cessation. Tobacco companies are marketing novel products (e.g., Phillip Morris' Accord, R.J. Reynolds' Eclipse) intended to reduce these risks. Evaluation of these products is necessary to determine if they increase, decrease, or fail to change smoking's health risks. This study examines the acute effects of the Accord system on cigarette smokers; the study extends a previous preliminary evaluation by controlling for the system's eight-puff/cigarette limit, smokers' brand preference, and the act of smoking. Smokers of light or ultra-light cigarette brands (> or = 10 cigarettes/day, 16 men and 16 women) participated in this within-subjects protocol. Prior to each of the four, Latin-square ordered, approximately 2.5-h sessions, subjects abstained from smoking for at least 8 h. In each session, subjects smoked eight puffs, at 30-min intervals, from either their own brand of cigarettes, a marketed brand that was not their own, de-nicotinized tobacco cigarettes, or the novel smoking system. Subjective and physiological effects were assessed regularly. Results confirmed previous observations that the withdrawal suppression, CO intake, and tachycardia produced by the novel system are all less than that produced by normally marketed cigarette brands, even controlling for the system's eight-puff limitation and for brand preference. Incomplete withdrawal suppression may increase smoking frequency, thus potentially offsetting any decreased risks associated with Accord use. Laboratory studies of the acute effects of novel smoking systems are an important part of a comprehensive evaluation program.
Adolescent↗
Initial tobacco use episodes in children and adolescents: current knowledge, future directions.
Approximately three-quarters of adult tobacco users report that their first tobacco use occurred between ages 11 and 17, while many adults who do not regularly use tobacco report that they experimented with it as adolescents. Surprisingly little is known about the effects of these initial tobacco use episodes and their influence on adult tobacco use patterns. In particular, understanding the role that nicotine plays in these early tobacco use experiences may be important in understanding the development of regular tobacco use and concomitant nicotine dependence. One goal of this review is to summarize current knowledge regarding the effects of initial tobacco use episodes in adolescents and to discuss nicotine exposure in initial tobacco use episodes. Another goal is to outline a research agenda designed to learn more about initial tobacco use episodes and the effects of nicotine in children. An ethical rationale and some potential methods for this research agenda are presented.
Adolescent↗
Naltrexone alters subjective and psychomotor responses to alcohol in heavy drinking subjects.
Preclinical studies support endogenous opioid system involvement in alcohol reinforcement and consumption; however, recent clinical trials and human laboratory studies have provided mixed findings of the effects of naltrexone (a non-selective opioid antagonist) on alcohol responses. This study used a within-subject design (n = 23) to investigate naltrexone effects (0, 50 and 100 mg qd) on subjective and psychomotor responses to alcohol (none, moderate, high) in heavy drinkers. Before alcohol administration, subjects reported decreased desire to drink alcohol when maintained on 50 mg compared with placebo naltrexone. Following alcohol administration, active naltrexone significantly increased subjective ratings of sedative, and unpleasant/sick effects and decreased ratings of liking, best effects and desire to drink. Naltrexone generally did not alter subjective or objective indicators of drunkenness. Finally, high doses of naltrexone and alcohol interacted to produce the greatest decreases in liking and best effects. Findings support the role of endogenous opioids as determinants of alcohol's effects and suggest that naltrexone may be particularly clinically useful in those treatment patients who continue to drink heavily.
Adult↗
A clinical laboratory model for direct assessment of medication-induced antihyperalgesia and subjective effects: initial validation study.
Analgesic medications are often tested in clinical laboratory studies by observing their ability to reduce the pain produced by noxious stimuli presented to healthy skin. These medications may then be used clinically to reduce disease-related hyperalgesia. This article describes a clinical laboratory model useful for testing a medication's ability to reduce hyperalgesia in humans. Results demonstrate that ultraviolet (UV) light induces hyperalgesia, commonly prescribed analgesic medications reduce UV-induced hyperalgesia, and this UV-induced hyperalgesia model can be used to assess the time course of a medication's antihyperalgesia effects. Coupled with participant-rated measures of drug liking and mood, this model may prove useful for predicting the clinical efficacy and side-effect profile of novel analgesic medications in cost-efficient and statistically powerful laboratory studies.
Adult↗